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T
he increasing prevalence of type 2 QOL in older adults (6 –13), it has never
diabetes is a major health concern. been tested specifically in a diabetic cohort Sun and Yang styles. Control subjects per-
Reducing the vascular complica- for benefits across multiple domains. formed sham exercise (e.g., seated calis-
tions of diabetes has been a primary focus If Tai Chi was shown to be effective thenics, stretching) (16).
of treatment. However, the less- for mobility and other health outcomes All testing was conducted by the ex-
recognized complications of physical dis- relevant to this cohort, it may present a ercise physiologist before randomization
ability, cognitive impairment, and viable alternative exercise modality. The and after completing 32 sessions (within
depression that impact on quality of life aim of this study was to examine the phys- 5 months of randomization). Mobility im-
(QOL) are also important primary care iologic impairments associated with mo- pairment was determined from measures
considerations in older patients with dia- bility in older adults with type 2 diabetes of balance and gait speed (habitual and
betes. and to investigate whether Tai Chi would maximal). Static balance (timed single-leg
Diabetes has been associated with a improve mobility in this cohort relative to stance with eyes open and closed), dy-
greater risk of decline in function and in- sham exercise. namic balance (3-m forward tandem
creased prospect of severe disability (1,2). walk), and balance index (summary score
Studies have sought to identify relation- RESEARCH DESIGN AND of static balance and postural control per-
ships or causal pathways between the syn- METHODS — We conducted a 16- formance on a Chattecx balance platform)
dromes of mobility, disability, and week single-blind, randomized, sham- (17) were measured.
neuropsychological function in adults exercise controlled trial with an intention- Physiological capacity assessments
with type 2 diabetes (1,3). Few have si- to-treat design. Baseline outcomes included knee extensor strength (one rep-
multaneously examined these factors po- assessment was blinded. The study was etition maximum), peak power, peak
tentially modifiable by physical activity approved by human research ethics com- contraction velocity, and endurance (18)
(4) across multiple domains or at more mittees of the Universities of Sydney and and overall exercise capacity (6-min
than one point in time. New South Wales. Written informed con- walk) (19). Health status included num-
The dose of aerobic and resistance ex- sent was obtained by participants. ber of comorbidities, body composition
ercise necessary to achieve metabolic ben- We studied 38 type 2 diabetic pa- (waist circumference, total body fat
efits in clinical trials has sometimes led to tients (79% female). We excluded pa- [%BF]) (20), fasting blood glucose, cog-
poor compliance (5). Older adults with tients who were physically active, nition (14), QOL (21), and attitude to-
diabetes, often characterized by long- institutionalized, or cognitively impaired ward diabetes (22).
term sedentariness, overweight/obesity, (Mini-Mental State Examination ⱕ24) Statistical analyses were performed
and multiple comorbidities, may demon- (14) or had arthritic pain, unstable condi- using Statview 5.0. Values are reported as
strate better adherence to a low-intensity, tions, or disease precluding them from means ⫾ SD or median (range). Groups
low-impact exercise, such as Tai Chi. Al- the planned exercises. Participants were were compared using t tests or 2. The effect
though Tai Chi has demonstrated im- randomly allocated to the Tai Chi or con- of time and group-by-time interactions
proved balance, gait speed, muscle trol groups, named Eastern or Western were analyzed with repeated-measures
strength, cardiorespiratory fitness, and exercise, both presented as being poten- ANOVA. Variables, different between
groups and their baseline values, were used
● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● as covariates in ANCOVA models. Relation-
From the 1Exercise and Sport Science Department, University of Sydney, Sydney, Australia; the 2Family ships between variables of interest were an-
Medicine Department, University of New South Wales, New South Wales, Australia; the 3Health Equity alyzed with multiple and forward stepwise
Training Research and Evaluation Department, University of New South Wales, New South Wales, Australia;
and the 4University of Sydney, Sydney, Australia, and Hebrew SeniorLife and Jean Mayer USDA Human
linear regression or Spearman rank-order
Nutrition Center on Aging, Tufts University, Boston, Massachusetts. correlation. Statistical significance was ac-
Address correspondence and reprint requests to Rhonda Orr, P.O. Box 170, Lidcombe, NSW, 1825, cepted at P ⱕ 0.05.
Australia. E-mail: r.orr@fhs.usyd.edu.au.
Received for publication 1 June 2006 and accepted in revised form 7 June 2006.
P.L. was the creator of the Tai Chi for Diabetes form and producer of its video and is the founder of Tai Chi
Productions, which distributes these videos and similar products and services. RESULTS — Participant characteris-
Abbreviations: %BF, total body fat; QOL, quality of life. tics and performance data are presented
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion in Table 1. Participants were obese (63%),
factors for many substances. displayed metabolic syndrome (82%),
DOI: 10.2337/dc06-1130 had one or more diabetes complications
© 2006 by the American Diabetes Association.
The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby (40%), had comorbidities (predomi-
marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact. nantly osteoarthritis [84%] and hyperten-
Table 1—Baseline characteristics of participants and outcomes after Tai Chi and sham exercise
Tai Chi (n ⫽17) Sham exercise (control) (n ⫽ 18) Change Group
over time effect
Characteristic Baseline Follow-up % change Baseline Follow-up % change P value P value
Age (years) 65.9 ⫾ 7.4 64.9 ⫾ 8.1
Duration of diagnosed type 2 diabetes (years) 8.5 (0–25) 9.0 (0.7–50)
Number of comorbidities 6.9 ⫾ 6.7 6.1 ⫾ 8.8
Cognition (0–30)*† 28 (25–30) 27 (23–30)
Weight (kg) 87.5 ⫾ 13.7 88.1 ⫾ 12.3 ⫺1.1 ⫾ 3.0 80.7 ⫾ 16.1 80.6 ⫾ 16.2 ⫺0.1 ⫾ 1.9 0.2 0.3
%BF†‡ 43.0 ⫾ 4.8 42.7 ⫾ 5.7 ⫺0.6 ⫾ 3.4 37.3 ⫾ 8.4 36.8 ⫾ 9.1 ⫺1.0 ⫾ 2.8 0.1 0.7
Waist circumference (cm)†‡ 106.1 ⫾ 14.6 108.2 ⫾ 13.2 0.5 ⫾ 3.4 98.4 ⫾ 12.6 98.7 ⫾ 12.5 0.4 ⫾ 2.8 0.4 0.9
Blood glucose (mmol/l) 7.6 (3.9⫺15.6) 7.5 (5.7⫺12.5) 7.7 ⫾ 28.8 7.9 (5.6⫺13.9) 7.4 (5.4⫺15.4) ⫺3.2 ⫾ 20.4 0.9 0.2
7.5 ⫾ 4.0 8.2 ⫾ 4.4 ⫺4.6 ⫾ 19.7 6.4 ⫾ 3.8 6.8 ⫾ 4.0 9.0 ⫾ 5.9
Enhanced balance and gait speed were 4. de Rekeneire N, Resnick HE, Schwartz AV, 14. Folstein MF, Folstein SE, McHugh PR:
not related to each other. Compliance, how- Shorr RI, Kuller LH, Simonsick EM, Vellas “Mini-Mental State:” a practical method
ever, was related to improved mobility, sug- B, Harris TB: Diabetes is associated with for grading the cognitive state of patients
gesting that the observed improvements subclinical functional limitation in non- for the clinician. J Psychiatr Res 12:189 –
disabled older individuals: the Health, 198, 1975
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fect. Unmeasured aspects of group partici- abetes Care 26:3257–3263, 2003 help prevent & control diabetes. In East
pation, such as changes in motor control, 5. Brandon LJ, Gaasch DA, Boyette LW, Action Videos. Narwee, Australia, Tai Chi
socialization, or neuropsychological func- Lloyd AM: Effects of long-term resistive Productions, 2001
tion, may explain our results. training on mobility and strength in older 16. Pu CT, Johnson MT, Forman DE, Hausdorff
In conclusion, mobility impairments adults with diabetes. J Gerontol A Biol Sci JM, Roubenoff R, Foldvari M, Fielding RA,
in an older, obese cohort with type 2 dia- Med Sci 58:740 –745, 2003 Fiatarone Singh MA: Randomized trial of
betes are associated with low muscle 6. Wolf SL, Barnhart HX, Kutner NG, Mc- progressive resistance training to counteract
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of Tai Chi and computerized balance 17. Orr R, de Vos N, Singh N, Ross D, Stavri-
cifically designed to improve muscle con- training: Atlanta FICSIT Group: Frailty
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and Injuries: Cooperative Studies of Inter- improves balance in healthy older adults.
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Acknowledgments — We thank Douglass 18. de Vos NJ, Singh NA, Ross DA, Stavrinos
tion for older adults. J Gerontol Nurs 22:
Hanly Moir Pathology for their sponsorship, TM, Orr R, Fiatarone Singh MA: Optimal
12–17, 1996
Keiser Sports Health for their donation of K400 load for increasing muscle power during
8. Hain TC, Fuller L, Weil L, Kotsias J: Effects
Electronics for pneumatic-resistance machines, explosive resistance training in older
of T’ai Chi on balance. Arch Otolaryngol
and the participants for their dedication. adults. J Gerontol A Bio Sci Med Sci 60:
Head Neck Surg 125:1191–1195, 1999
9. Christou EA, Yang Y, Rosengren KS: Taiji 638 – 647, 2005
training improves knee extensor strength 19. Guyatt GH, Sullivan MJ, Thompson PJ,
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